Ace the Case: A 15-Year-Old Girl With Morbid Obesity

Case Presentation

Chief Complaint: Routine check-up.

History of Present Illness: Miss M is a 15-year-old girl who presents to her primary care physician for a routine annual examination. She has no complaints and states she feels “fine.”

Past Medical or Surgical History: None.

Medications: None.

Family History: Significant for obesity; both parents meet criteria for morbid obesity.

Social History: She is a high school student. She is not sexually active and denies any alcohol, smoking, or drug use.

Vital Signs: Height: 5’6”; weight: 260 pounds; body mass index (BMI): 42 kg/m2; blood pressure: 128/88 mm Hg, bilaterally; heart rate: 89 beats per minute; respirations: 18 breaths per minute; temperature: 98.7°F.

Physical examination: General: no acute distress; HEENT: pupils equal, round, and reactive to light and accommodating (PERRLA); cardiovascular: heart regular rate and rhythm; lungs: clear to auscultation bilaterally; abdomen: soft, obese, nontender; extremities: trace edema bilaterally, nontender.

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Which of the following is the most likely cause of the patient’s obesity?
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Correct answer: A

Rationale: Obesity in children and adolescents is typically secondary to environmental factors, such as poor diet and sedentary lifestyle.1 Although genetic or endocrine disorders do occur (Answers B, C, and D), they comprise <1% of cases.1 Genetic testing for obesity syndromes should be performed in cases of extreme obesity for children younger than 5 years, for hyperphagia, or for those with a concerning family history.2 The Endocrine Society recommends against routine screening for endocrine etiologies for childhood obesity unless the patient’s height or height velocity are attenuated.2